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Case Study

Transformed Healthcare Credentialing for a HealthTech Company

Industry: Healthcare

Project Overview

Goal

Implement a customized system with ticketing, reporting, processes, and training to streamline credentialing, cut costs, boost compliance, and improve margins.

Results

Lower Operational Costs, Higher Operating Margin & Upgraded Compliance

Background

Client is a Healthcare technology platform that helps healthcare organizations optimize their provider networks and streamline the credentialing process using data-driven technology and automation.

Engagement Outline

  • Challenges
  • Slow & Inefficient Credentialing Processes: The client’s credentialing process was far slower than industry standards, creating a backlog of over 11,200 pending monthly requests and hindering their ability to meet demand.
  • High Recruitment Costs and Staff Turnover: Manual processes and high (30%) staff turnover drove up operational costs. Expensive temporary staff and a lack of automation further hampered efficiency and created a cycle of high costs and low output.
  • Inability to Manage Ticket Volume & Increase in Unresolved Cases: A 25% year-over-year surge in ticket submissions, peaking at 70,000 monthly, overwhelmed the client’s outdated system, leading to a 20% increase in unresolved cases.
  • Key Solutions Implemented
  • Implemented a Customized Ticketing System: A new ticketing system was developed, reducing processing time from 20 days to 8 days and cutting the backlog by 80%. The system efficiently tracked all key activities, from average handling time (AHT) to provider details and productivity metrics, ensuring a smooth workflow.
  • Real-Time Reporting Enabled Process Optimization: Implemented Power BI for faster decision-making, reducing report generation time from 1 week to real time reporting. With updates every 15 minutes, the system now provides near real-time monitoring of team production and error rates.
  • Established KPI & Performance Driven Process: KPIs were established to drive efficiency across more than 60 types of requests. This improved process efficiency reduced operational costs. The firm set AHT targets and capped quality goals, allowing performance tracking by client and team, ensuring consistent delivery.
  • On-Going Staff Training and Performance Monitoring: A comprehensive training program coupled with real-time performance monitoring resulted in a 35% reduction in errors and a 60% decrease in compliance breaches. The integration of a proprietary QA tool and ticketing system with Power BI enhanced the firm’s ability to address errors and maintain high standards of compliance.

Conclusion

This four-year partnership has delivered remarkable results, significantly improving efficiency, quality, and market reach. Maintaining a 98% quality score across 70,000 monthly tickets and 60+ request types highlights the effectiveness of processes and QA feedback. Real-time Power BI reporting has enabled data-driven decisions. An 800% workforce scale has facilitated increased volume and fueled a 20% market capacity expansion in six months, positioning the client for continued growth.

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